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oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Globus sensation is a subjective feeling of a lump or foreign body in the throat. It is sometimes called globus pharyngeus. The term globus hystericus was previously used because of the belief that psychogenic factors were involved and that globus sensation was just a type of somatisation disorder presenting with pseudoneurological symptoms.[1][2] However, it is now widely considered that globus sensation can have underlying physiological or anatomical causes.[2]

Epidemiology

Globus sensation is thought to be a common symptom.[3] It accounts for around 5% of new referrals to ear, nose and throat (ENT) outpatient clinics.[4] Old surveys suggest that up to 46% of apparently healthy people complain of the symptom.[5] There is no difference in prevalence between the sexes. However, it is thought that women, more frequently than men, visit a doctor because of the symptom.

Gastro-oesophageal reflux disease. Reflux of gastric contents may lead to irritation and inflammation of the laryngopharynx, or increased tone in the upper oesophageal sphincter may be triggered by either distention, or acid, in the distal oesophagus.[6][7]

Raised upper oesophageal sphincter pressure.

Oesophageal motor disorders.

Conditions causing irritation or inflammation of the pharynx - for example, pharyngitis, tonsillitis, and postnasal drip secondary to chronic sinusitis. It is thought that such problems lead to increased sensitivity of the pharynx.

Hypertrophy of the base of the tongue.

A retroverted epiglottis.

Psychological factors. Some studies have shown that stress may exacerbate symptoms of globus.[8] However, others have not supported psychological factors as a cause.

Presentation

The symptom of a lump in the throat tends to come and go. It is usually felt in the front of the neck and can move up and down. It does not affect eating and drinking and in fact, symptoms may be alleviated by this. There is no pain. Symptoms are often noticed when swallowing saliva.

Differential diagnosis

The differential diagnoses are the causes of true dysphagia. See separate article Dysphagia for further details.

Investigations

Careful history taking is important to try to differentiate between a globus sensation symptom and true dysphagia. Be alert to red flag symptoms including weight loss, dysphagia, throat pain and hoarseness.

Physical examination of the neck and outpatient nasolaryngoscopy in an ENT clinic may be all the investigation that is needed if there are typical symptoms of globus sensation with no red flag symptoms or signs.[2][9]

Other investigations may be carried out if diagnosis is uncertain, including:[2]

Empirical therapy with a proton pump inhibitor may be started if there is suspicion of gastro-oesophageal reflux disease and if history taking, neck examination and nasolaryngoscopy have not revealed any red flag symptoms or abnormal findings. If symptoms persist then further investigation may be needed (as under 'Investigations', above).

Prognosis

Not many long-term follow-up studies have been carried out. One small study following 74 patients found that 45% still had persistent symptoms after around seven years.[10] Another small study showed that symptoms had improved in 60% of patients after five years, with the best outcome being in male patients who had globus sensation symptoms for less than three months with no other associated throat symptoms.[11]

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.